700530.pdfI P
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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NAME
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CITY
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.L MAP NO.: PERMIT
NUMBER 700530
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13 YES (3 NO
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STRZET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
__T;rz���ICOMP. PLAN ST. R/W ............ PT. . ............ FT.
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RESIDENTIAL
R
GAS
LINE
NEW
NON-RESIDENTIA
SIGN
ADD
H
I�NIING
ZALL
DEMOLISH
tKALTER EXCAVATE
OR FILL
PENCE
( x Ft.)
.......... ..........
REPAIR PRE -MOVE
INSP.
swill
POOL
NUMBER OF
DWELLING
UNITS
LWS rf
FIRI� �ZO TYPE'!?NSTRUCTION
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[j YES
0 Yr.8 [] NO
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3
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NATURE OF WORK TO BE DONE
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Plan Check No .....................
Valuation
Fee
Receipt No.
BUILDING
PROPOSED UBE
PLUMBING
_FLOT PLAN (Inqlcato Bunningi setbacks, abutting streets)
BEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPEC
EXCAVATION OR F
TOTAL AMOUNT DUE
3,
I hereby acknowledge that I have read this application; that the In-
formation given in correct; and that I gun the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
ATMNTION
THIS PERMIT
APPLICATION APPROVAL
This application is not a permit until
relating to Workmem-a Compensation Insurance.
NOTE: Permit Limit One Year (Except DE51OLITIONS which
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
AUTHORIZES
ONLY THE
WORK NOTED
signed by the Building official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
pleted in six months.)
31ONATURE JOWNER OR AGENT) LDATE SIGNED
2EL GALVL' 6LI-6-70
NOTE: Applicant Subject to Plan Cbech Fee
INSPECTION
DEPARTMENT
CITY OF
EDNIONDS
PR 6-1107
DIRECTOR'S SIGN RP
Am
DATE
Thin Permit coven work to be done on private property ONLY.
Any construction on the Public domain (curbs, sidewalks, driveways,
ranzqueen, etc.) will require separate permission.
FILE
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